Active NPI
Casey Haycock, CPHT
- Pharmacy Technician
- Boise, ID
National Provider Identifier
1003475443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- CT20939
- Practice address
- 10500 W Overland Rd
Boise, ID 83709-1435 - Phone
- (208) 376-4101
- NPI assigned
- Jun 10, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | CT20939 | ID | Primary |
Addresses
Primary practice location
10500 W Overland Rd
Boise, ID 83709-1435
Mailing address
10500 W Overland Rd
Boise, ID 83709-1435
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CT20939 | ID | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560124800000",
"number": "1003475443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10500 W OVERLAND RD",
"city": "BOISE",
"state": "ID",
"postal_code": "837091435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10500 W OVERLAND RD",
"city": "BOISE",
"state": "ID",
"postal_code": "837091435",
"telephone_number": "208-376-4101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAYCOCK",
"first_name": "CASEY",
"credential": "CPHT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-06-10",
"last_updated": "2019-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "ID",
"license": "CT20939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.